Shiri Lev - Ari , Michael D ' Arcy and Boaz Keysar Interns

OBJECTIVE: Theories from the psychology of communication may be applicable in understandingwhy hand-off communication is inherently problematic. Thepurposeof this studywas toassesswhetherpostcall pediatric interns can correctly estimate the patient care information and rationale received by on-call interns during hand-off communication. METHODS: Pediatric interns at the University of Chicago were interviewed about the hand-off. Postcall interns were asked to predict what on-call interns would report as the important pieces of information communicated during the hand-off about each patient, with accompanying rationale. Postcall interns also guessed on-call interns’ rating of howwell the hand-offs went. Then, on-call interns were asked to list the most important pieces of information for each patient that postcall interns communicated during the hand-off, with accompanying rationale. On-call interns also rated how well the hand-offs went. Interns had access to written hand-offs during the interviews. RESULTS: We conducted 52 interviews, which constituted 59% of eligible interviews. Seventy-two patients were discussed. The most important piece of information about a patient was not successfully communicated 60% of the time, despite the postcall intern’s believing that it was communicated. Postcall and on-call interns did not agree on the rationales provided for 60% of items. In addition, an item was more likely to be effectively communicated when it was a to-do item (65%) or an item related to anticipatory guidance (69%) comparedwith a knowledge item (38%). Despite the lack of agreement on content and rationale of information communicated during hand-offs, peer ratings of hand-off quality were high. CONCLUSIONS: Pediatric interns overestimated the effectiveness of their hand-off communication. Theories from communication psychology suggest that miscommunication is caused by egocentric thought processes and a tendency for the speaker to overestimate the receiver’s understanding. This study demonstrates that systematic causes of miscommunication may play a role in hand-off quality. Pediatrics 2010; 125:491–496 AUTHORS: Vivian Y. Chang, MD,a Vineet M. Arora, MD, MA,b Shiri Lev-Ari, MA,c Michael D’Arcy, BA,d and Boaz Keysar, PhDc aDivision of Pediatric Hematology/Oncology, University of California, Los Angeles, Los Angeles, California; Departments of bMedicine and cPsychology, University of Chicago, Chicago, Illinois; and dDepartment of Medical Anthropology, University of California, Berkeley, Berkeley, California